Trapezium fractures are uncommon carpal bone injuries. They can either occur in isolation or in combination with other carpal bony injury.
They can be broadly classified into ridge (most common 2) and body fractures.
They often occur as a result of a high energy trauma and usually involves either direct or indirect axial loading 1. These are most commonly transverse loading injuries in the setting of an adducted thumb in which the first metacarpal is driven into the trapezium 5.
Trapezial ridge fractures may result from a direct blow to the volar surface, dorsoradial impaction or an avulsion injury. Fractures of the trapezial body result from an axial loading or shearing force through the first carpometacarpal joint.
Trapezial fractures are often associated with a fracture of the first metacarpal base and/or subluxation or dislocation of the first carpometacarpal joint.
Trapezial ridge fractures may be associated with wrist injuries, including distal radial fractures.
Non displaced fractures can sometimes be occult. A Robert’s AP view, with the hand in full pronation, is a good way of visualising the trapezium on plain radiographs. If the diagnosis is still in question a CT or bone scintigraphy could be considered.
Trapezial ridge fractures may be overlooked at routine wrist radiography. Carpal tunnel radiographs may be helpful to detect this fracture 2, whereas CT imaging can be diagnostic.
Treatment and prognosis
Displaced fractures may require open reduction and internal fixation, typically performed with Kirschner wires or screws.
If corticated, consider accessory ossicles in this region such as
- 1. Ramoutar DN, Katevu C, Titchener AG et-al. Trapezium fracture - a common technique to fix a rare injury: a case report. Cases J. 2009;2 : 8304. doi:10.4076/1757-1626-2-8304 - Free text at pubmed - Pubmed citation
- 2. Kaewlai R, Avery LL, Asrani AV et-al. Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics. 2008;28 (6): 1771-84. doi:10.1148/rg.286085511 - Pubmed citation
- 3. Wiesler ER, Chloros GD, Kuzma GR. Arthroscopy in the treatment of fracture of the trapezium. Arthroscopy. 2007;23 (11): 1248.e1-4. doi:10.1016/j.arthro.2006.07.051 - Pubmed citation
- 4. Schmitt R, Lanz U. Diagnostic Imaging of the Hand. George Thieme Verlag. (2008) ISBN:3131405813. Read it at Google Books - Find it at Amazon
- 5. Goldfarb CA et.al. Wrist Fractures: What the Clinician Wants to Know1. Radiology. 2001;219 (1): 11-28. Radiology (full text)
Wrist and hand fractures
- wrist and hand fractures (Amsterdam wrist rules)
- distal radial fracture (Frykman classification)
- distal ulna fractures
- fracture dislocations of the radius and ulna
- carpal fractures
- metacarpal fractures
- phalanx fractures